Annals for Educators - February 2023
Authors: Christine Laine
Journal: Annals of Internal Medicine (2023)

Web ExclusivesFebruary 2023Annals for Educators - February 2023FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202302210 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsShort-Term Adverse Outcomes After Mifepristone–Misoprostol Versus Procedural Induced Abortion. A Population-Based Propensity-Weighted StudyThe War on Reproductive Health Care in the United StatesThis population-based cohort study compared the risk for adverse events within 42 days of a medical or procedural abortion in Ontario, Canada, where mifepristone–misoprostol has been available free of charge in pharmacies to pregnant persons with a prescription from a physician. The accompanying editorial discusses the findings and why access to safe abortion, along with access to effective contraception, is critical to improving maternal morbidity and mortality in the United States.Use this article and the editorial to:Invite an OB-GYN specialist to join your session to review the medical and procedural options for elective termination of pregnancy during the first trimester.Discuss propensity score weighting in observational studies such as this one.Review the results of the study, and discuss how factors in addition to the observed complication rates are relevant to patient decision making about the method of abortion.Review the recent FDA decision regarding mifepristone access in the United States. High- Versus Low-Dose Exercise Therapy for Knee Osteoarthritis. A Randomized Controlled Multicenter TrialThis trial assigned patients with diagnosed knee osteoarthritis and a history of pain and decreased knee function to high- or low-dose medical exercise therapy and evaluated differences in Knee Injury and Osteoarthritis Outcome Scores between groups at 3 months, as well as pain intensity and quality of life.Use this article to:Review the management of osteoarthritis. This In the Clinic review may be useful. Invite a physical therapist to your session to discuss the types of exercises that are recommended for patients with knee osteoarthritis.Discuss the findings of the trial and how you could use them to advise a patient with knee osteoarthritis to choose between a low-dose exercise program and a high-dose program.Pharmacologic Treatment of Primary Osteoporosis or Low Bone Mass to Prevent Fractures in Adults: A Living Clinical Guideline From the American College of PhysiciansEffectiveness and Safety of Treatments to Prevent Fractures in People With Low Bone Mass or Primary Osteoporosis: A Living Systematic Review and Network Meta-analysis for the American College of PhysiciansOsteoporosis Treatment: Not EasyIn the first article, the American College of Physicians updates its 2017 recommendations on pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults. These updated guidelines examine new evidence comparing different therapies among all at-risk populations, including men. The second article describes a systematic review that compared different treatment options for low bone mass or osteoporosis to prevent fractures. The authors summarize the harms and benefits from 34 randomized trials and 36 observational studies. The author of the accompanying editorial discusses why pharmacologic treatment of osteoporosis is not easy and believes that the recommendations do not adequately consider the severity of bone loss and the high risk for vertebral fractures after denosumab discontinuation.Use these articles and the editorial to:Watch a brief video describing the systematic review that provides the evidence base for the ACP recommendations. Review the ACP recommendations, and discuss the characteristics of patients who are candidates for pharmacologic therapy to prevent osteoporotic fractures.Discuss how to select from among the available pharmacologic therapies.Discuss appropriate follow-up of patients receiving pharmacologic interventions for osteoporosis. Is routine testing indicated? When should therapy be discontinued?Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder: A Living Clinical Guideline From the American College of PhysiciansNonpharmacologic and Pharmacologic Treatments of Adult Patients With Major Depressive Disorder: A Systematic Review and Network Meta-analysis for a Clinical Guideline by the American College of PhysiciansCost-Effectiveness of First- and Second-Step Treatment Strategies for Major Depressive Disorder. A Rapid ReviewValues and Preferences of Patients With Depressive Disorders Regarding Pharmacologic and Nonpharmacologic Treatments. A Rapid ReviewThe American College of Physicians Living Guideline on Depression: A Step Forward, but Gaps RemainThe American College of Physicians has updated its 2016 recommendations on pharmacologic and nonpharmacologic treatment of major depression and has made recommendations for initial or second-line treatment during the acute phase of an episode of major depressive disorder. The update is based on a series of systematic reviews that summarize studies on effectiveness, cost-effectiveness, and patient values and preferences for different pharmacologic and nonpharmacologic interventions for initial and second-line treatment of major depression. The authors of the accompanying editorial appreciate the recommendations' focus on the patient's role in shared decision making, the careful attention to potential conflicts of interest, and the systematic approach, but they note gaps in the consideration of nondrug interventions.Use these articles and the editorial to:Watch a brief video describing the systematic review that provides the evidence base for the ACP recommendations. Review the ACP recommendations, and discuss how to decide whether to recommend cognitive behavioral therapy or medication for a patient with depression.Discuss how to select from among the available pharmacologic therapies.Discuss appropriate follow-up of patients receiving pharmacologic interventions for osteoporosis. Is routine testing indicated? When should therapy be discontinued?Beyond the GuidelinesHow Would You Resuscitate This Patient With Septic Shock? Grand Rounds Discussion From Beth Israel Deaconess Medical CenterSepsis is a common and potentially life-threatening condition, but achieving consensus about optimal diagnosis, treatment, and quality measurement has proved to be contentious. In this article, 2 experts discuss and debate how best to care for a patient with sepsis in the context of updated 2021 guidelines from the Surviving Sepsis Campaign.Use this article to:Watch the patient video with your learners, and then ask how they would manage this patient.Review the 2021 recommendations of the Surviving Sepsis Campaign.Have your learners test their knowledge by completing the quiz that accompanies the article.Medical KnowledgeThe Dark Side of Rapid Reviews: A Retreat From Systematic Approaches and the Need for Clear Expectations and ReportingRapid reviews proliferated during the COVID-19 pandemic. In this commentary, the authors highlight some risks and concerns with rapid reviews and make suggestions for reviewers and proponents of evidence-based practice going forward.Use this article to:Discuss the difference between narrative and systematic reviews. This article can help inform the discussion. Review a rapid review with your learners and identify any concerns about the methodology. An example is provided here. Chagas DiseaseChagas disease, which is caused by infection with the parasite Trypanosoma cruzi, is a leading neglected tropical disease in the United States. An estimated 240 000 to 350 000 people in the United States are infected, primarily immigrants from Mexico, Central America, and South America, where the disease is endemic. The parasite is transmitted by the triatomine bug but can also be passed vertically from mother to child or via blood transfusion or organ transplant. Approximately 30% of infected people develop end-organ complications, including cardiomyopathy, arrhythmias, thromboembolic disease, and gastrointestinal complications. Chagas disease can be associated with significant morbidity and mortality, but early diagnosis and treatment can help prevent complications. Primary care providers should consider serologic testing in at-risk patients and screening in Latinx immigrants. Benznidazole or nifurtimox can be used for treatment, and specialists in infectious disease, cardiology, and gastroenterology may be helpful in addressing management.Use this article to:Discuss the presentation of Chagas disease. Who is at risk for it?Ask your learners whether they have any patients with Chagas disease. How was it diagnosed?Review the complications of Chagas disease.Review the available therapeutic strategies for treating Chagas disease.Test your learners' knowledge by having them complete the quiz that accompanies the article and then reviewing the correct answers.Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Christine Laine, MD, MPHAffiliations: From the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics February 2023Volume 176, Issue 2 ePublished: 21 February 2023 Issue Published: February 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. 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